Loading...
HomeMy WebLinkAbout0419 SOUTH MAIN STREET - Health 419 South Main Street Centerville A= 207-065 S M E A D No.2-153LOR UPC 12534 smead.com • Made In USA .A i'tr 01mmUSwmrFmp ODU Lm A MIIAMLSi�OGRAMOD6 No. t/X(87 THE COMMONWEALTH OF MASSACHUSETTS FEE BOARD OF HEAL1`'H T D of �4 rnsi-cam b1e APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct ( ) Repair ( ) Upgrade ( ) Abandon ( ) - ❑Complete System []Individual Components y l9 Sou+h A3 a- St, I-rn+e-rvllte. JObAnn nal1P'-2-1 LocatioP LA 1 A ner's N me -'0 6 -1 7� _ rjparcel#� �, ` Address (-rc Q (P 3- f025 S Lo ,..� lephone# t� + C�t - ayun � nDeerIf 1i fnsviler's Nark r AQ+ Dgsign r' amem Addr 5o8 -1-7 6s_j Telephone# Telephone# Type of Building: Lot Size Sq.feet Dwelling—No.of Bedrooms 5 Garbage Grinder ( ) Other—Type of Building No.of persons Showers ( ), Cafeteria ( ) Other fixtures Design Flow(min.re uir ) 5 5 gpd Calculated design flow gpd Design flow provided gpd Plan: Date ►a�+�� Number of sheets Revision Date Title Description of Soil(s) Soil Evaluator Form No. Name of Soil Evaluator -Tlnh-e-6"1 Date of Evaluation DESCRIPTION OF REPAIRS OR ALTERATIONS The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees not to place the system in operation until a Certificate of Compliance has been issued by the Board of Health. Signe Date 16 23 1 D toInspeC � FORM t - APPLICATION FOR DSCP DEP APPROVED FORM 5/96 1 TOWN OF BARNSTABLE LOCATION y 19 So,)-1)% 07, n .571 rct SEWAGE#aoo8- NS a VILLAGE ASSESSOR'S MAP&PARCEL, 10`7 - GS' INSTALLERS NAME&PHONE NO. j3 B L mAyA-rT-oeJ 5-008-Y71- 01,53 SEPTIC TANK CAPACITY f 000 - I SOO LEACHING FACILITY.(type) 56o9a! ck,,.,S ( ,4) (size) x ya x 2 NO.OF BEDROOMS s' OWNER .�oV-,anr\ Eng)c ri PERMIT DATE: 10- 2/ - d$ COMPLIANCE DATE: /O-Z 8-O 8 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility.(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY Ai- �s' Bz-st" A3' n' 03.47'6" REAR Aq. w' A 9W Bq-4� �' f i3L ,A%7, L41 G g'7- s 7' L3 CARA'GE' No. i P '` THE COMMONWEALTH OF MASSACHUSETTSxtf FEE ;B0ARD OF HEALTH v>> o f A r n 6+ APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct ( ) Repair ( ) Upgrade ( ) Abandon ( ) - ❑Complete System 0 Individual Components i h /"n I C)fit-'` (f f�I P r V I I1 e-- �bA t n �n n ' Locatio t . `tom` O ner's Name D � t �O 5" �,_ L11 �1 �1 c1 I In �a+ 6-t-,i e r v I I i E �h 7.'�j G Vp/Parcel t Address i �F (P 1 11(7, lephone# ' .U1�er-1 u y c� ( r^.i �— nstaller's Narap- Designer' Name ' 1 W ecl bed f ILr A L) I C. t �lrj -e � �1r Address s Telephone# Telephone# If Type of Building: ICf' !6 P q(0. Lot Size Sq.feet ' 4 Dwelling—No.of Bedrooms 5 Garbage Grinder ( ) J Other—Type of Building No.of persons Showers ( ), Cafeteria ( ) J Other fixtures I� \ Design Flow(min.required) 5 gpd Calculated design flow gpd Design flow provided gpd Plan: Date �L4112 b Number of sheets �} -. Revision Date Title " Description of Soil(§) Soil Evaluatox.Form No. --Name of Soil Evaluatb ,T1L V -ei v Date of Evaluation "1 a � 'DESCRIPTION OF REPAIRS OR ALTERATIONS 1 I 4q The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions ofl € TITLE 5 and further agrees not to place the system in operation until a Certificate of Compliance has been issued by the Board of Health. a Signed, \ Date Inspection ` 0/0—q G Z }_ ' i FORM I - APPLICATION FOR DSCP DEP APPROVED FORM 5/96 - NO. THE COMMONWEALTH OF MASSACHUSETTS FEE I'�C�d i1�i h ahl� BOARD OF HEALTH i CERTIFICATE OF COMPLIANCE Description of Work: ❑ Individual Component(s) ❑Complete System The undersigned hereby certify that the Sewage Disposal System;Constructed( ),Repaired Upgraded( ),Abandoned( ) by: \I G A I at t.� �� �l i 1,) C0+_ V f"n � PC 'fit l I has been installed in accordance with the provisions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to application No.��`�sue` dated )G �� Approved Design Flow S 50 (gpd) Installer (J�. £�'f 1 C�1 C� U { ; '�. Designer: !.il''\n,s 1. (('I+af' r�f�tai I r�P f i(`� Inspector The issuance of this certificate shall not be construed as a guarantee th t the system will function as designed. /Q FORM 3 - CERTIFICATE OF COMPLIANCE DEP APPROVED FORM 5/96 I i No. �- THE COMMONWEALTH OF MASSACHUSETTS FEE I l aClf (l ,iC_� h BOARD OF HEALTH DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereby granted to Construct ( ) Repair Upgrade ( ) Abandon ( ) an individual sewage disposal system at U t 1/t (fl r-,-4- F' I F-,€ y t 1 I t'.. as described in the application for Disposal System Construction Permit No. dated ICI Provided: Construction shall be ompleted within three years of the dat phis p rriTit.All local conditions m be met. Date ��LU� Eoard of I��abth —� `5 FORM 2 - DSCP DEP APPROVED FORM 5/96 FORM 1255 (REV 5/96) H&W HOBBSB WARREN TM PUBLISHERS- BOSTON �� �'�� 1������; ������cz r r FROM :down cape en•gineering inc FAX NO. :15083629880 Oct. 29 2008 01:19PM P1 Town of Barnstable =" regulatory Services Thomas F. Geiler,Director SARNKi'Al1LS, MAO& Public Health Division 't`llomity McKean,Director 200 Main Street,Hyannis,MA 02601 C>tt'ice: 508-862-4644 Pax: 508-790-63(YY4 Installer &_Designer Ccrtificatiyn.Form Date: _ Sewage Permit# _ Assessor's MaplPareel��7 Designer: '�� e CA i n ee Insta)Jer: 4 f id E),CCa✓ahD/1 Address: - A.ddresQ: �7 �'��&-K- Z—ac-Ik 1 Oil lx u V.P was issued a permit to install a (date) (installer septic sysLenx a .a �Jr7t�`1'� Ma I , y (. -- based on a design drawn by (address) �D�Jv1 2 •//I t7,¢ +� dated Y �� ( esigner I artily that the septic system referenced above was installed substantially according to the design, which may include iiainor approved changes such as lateral relocation of the distribuiion box andlor septic tank. 1 certify that the septic system referenced above was installed with major changes (i.e. greater titan 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Flan revision or certified.as-built by designer to f611ow. � �IK of MAS�r - �o� ARNE H cy: ((nstalJer s i 11flUre) DJALA � CIVIL. Nc. 30792 1� � QPn �'/�STEP��i<4• (Designer's Signature) (Affix D kp Here) PURASV RIETURN TO BARNSTABLE PUBLIC HEALTH DIV.iS.ION. CERTIFICATE OF COMPLIANCE WILL. NOT bIr, 1SSUTn UNTIL, B011I THIS 1F013M AND .AS-I3UJI'T C%ARiI ARF :I.ti;C JeXVY"0'1 Y'1`F11, FT,AX(N, TABLE PUBLIC;HFAi,TH AIV1S101�T. THANK YOU O:1 tealtfl/5eptic/Desigiier Certification Form 3-26-04.doc C .t I ell.c k le\ � s T FZR 0 h2oo°f o i/( e, Ay`oq Kvv-\ _ r Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ' M 419 South Main Street Property Address Johann Englert Owner Owner's Name information is required for every Centerville MA 02632 8/31/11 page. Citylrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information on the computer, - � ./7� use only the tab 1. Inspector: y✓ key to move your U cursor-do not Ricky L. Wright use the return key. Name of Inspector B & B Excavation, Inc. ,y Company Name 14 Teaberry Lane Company Address Forestdale MA 02644 City/Town State Zip Code 508-477-0653 S 14595 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 8/31/11 inspector's Signature \ Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP) within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original shou;ldfbe sent to the system owner and copies sent to the buyer, if applicable, and the approving authqrty_ - This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. 9 :z i 1i 1 d"'s ,.1 ]110=51S i I 21A, A N hA 01 t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Dis sal Syste •Page 1 0 17 ? R � Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 419 South Main Street M Property Address Johann Englert Owner Owner's Name information is required for every Centerville MA 02632 8/31/11 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND) for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): l5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 419 South Main Street Property Address Johann Englert Owner Owner's Name information is required for every Centerville MA 02632 8/31/11 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments "M 419 South Main Street Property Address Johann En lert Owner Owner's Name information is required for every Centerville MA 02632 8/31/11 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than %day flow t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments c°M 419 South Main Street Property Address Johann Englert Owner Owner's Name information is required for every Centerville MA 02632 8/31/11 page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments GSM , 419 South Main Street Property Address Johann Englert Owner Owner's Name information is Centerville MA 02632 8/31/11 required for every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 5 Number of bedrooms (actual): 5 I DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 550 t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °wM 419 South Main Street Property Address Johann Englert Owner Owner's Name information is required for every Centerville MA 02632 8/31/11 page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 1 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ® Yes ❑ No Seasonaluse? ❑ Yes ® No Water meter readings, if available last 2 ears usage d n/a 9 ( Y 9 (gP ))� Detail: Sump pump? ❑ Yes ❑ No Last date of occupancy: Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 419 South Main Street Property Address Johann Englert Owner Owner's Name information is required for every Centerville MA 02632 8/31/11 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ❑ No If yes, volume pumped: gallons .How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 i r Commonwealth of Massachusetts ROWW Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 419 South Main Street 'M Property Address Johann Englert Owner Owner's Name information is required for every Centerville MA 02632 8/31/11 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 2008 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 8"feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: 40' feet Comments(on condition of joints, venting, evidence of leakage, etc.): At time of inspection building sewer appears to be in good condition. No sign of leakage Septic Tank(locate on site plan): Depth below grade: 6-1feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years � Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 5'8"X 5'8"x 10'6" Sludge depth: 611 t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 +' Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 419 South Main Street Property Address Johann Englert Owner Owner's Name information is required for every Centerville MA 02632 8/31/11 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle no sludge Scum thickness no sludge Distance from top of scum to top of outlet tee or baffle no sludge Distance from bottom of scum to bottom of outlet tee or baffle no sludge How were dimensions determined? scour stick Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): (2) septic tanks(1) 1000 gallon tank and (1) 1500 gallon tank. At time of inspection septic tanks appears to be structurally sound. Tees and baffles present-no sign of leakage Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 L Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ;M 419 South Main Street Property Address Johann Englert Owner Owner's Name information is required for every Centerville MA 02632 8/31/11 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 419 South Main Street Property Address Johann Englert Owner Owner's Name information is required for every Centerville MA 02632 8/31/11 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): At time of inspection d-box appears to be in good condition Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 6 i Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 419 South Main Street Property Address Johann Englert Owner Owner's Name information is required for every Centerville MA 02632 8/31/11 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: (4) ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): At time of inspection leaching appears to be in good condition. No sign of damp soils or hydraulica failure Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 419 South Main Street Property Address Johann Englert Owner Owner's Name information is required for-every Centerville MA 02632 8/31/11 page. CityrTown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 CCommonwealth of Massachusetts ' W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 419 South Main Street Property Address Johann Englert Owner Owners Name information is required for every Centerville MA 02632 8/31/11 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately Efm �3_ �I I : RI✓�� 33 c � Q 40 1 0 1 a , 60*6 t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 i Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 419 South Main Street Property Address Johann Englert Owner Owner's Name information is required for every Centerville MA 02632 8/31/11 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: > 12'feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database -explain: You must describe how you established the high ground water elevation: augered hole Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 419 South Main Street Property Address Johann Englert Owner Owner's Name information is required for every Centerville MA 02632 8/31/11 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 Barnstable j Town of Barnstable MktnedeaCft Y ' k Regulatory Services Department k BAMSTABC+� 6 MASS_ Public Health Division 1639. 14+ m 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 _Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO April 29, 2008 Raymond Shannon 150 Ledgewood Road Dedham, MA 02026 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE,TITLE 5 The septic system located at 419 South Main Street, Centerville MA was last inspected on April 15, 2008,by Patrick O'Connell, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system"Needs Further Evaluation" under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following:. • Septic tank is leaking. • Garage apartment has a single cesspool • Insufficient system capacity for number of bedrooms. You are ordered to repair or replace the septic system within Two (2)years from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. a 9n, R. B OF HEALTH ,.CHO Agent of the Board of Health CERTIFIED MAIL# 7006 2150 0002 1038 7251 Q:\SEPTIC\Letters Septic Inspection Failures\419 South Main Street.doc N� Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 419 South Main Street, Centerville MA 02632 45it q g 1 S Property Address Estate of Raymond Shannon C/O Gilmore Rees Carlson & Cataldo Attn: Paul Bishop Owners Name me information is 20 Walnut Street, Wellesley MA 02481 April 15, 2008 -required for Y every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Important:When filling out A. General Information forms on the computer,use 1. inspector: �� D only the tab key to move your Patrick M. O'Connell cursor-do not Name of Inspector use the return key. Septic Inspection Services Co. r Company Name r9 189 Cammett Road Company Address Marstons Mills MA �02648 Cityrrown State Zip Code 508-428-1779 Telephone Number License Number _. B. Certification ' I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system' ❑ Passes ❑ Conditionally Passes ❑ Fails ® Needs Further Evaluation by the L oca!Approving Authority April 15, 2008 Ins 2 ector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. 08-84 Shannon.doc•08/06 Title 5 Official Inspection Form.Subsurface Sewage Disposal System•Page 1 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments w 419 South Main Street, Centerville MA 02632 Property Address Estate of Raymond Shannon C/O Gilmore Rees Carlson &Cataldo Attn: Paul Bishop Owner Owners Name information is 20 Walnut Street Wellesle MA 02481 April 15, 2008 required for , Y every page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Answer yes, no or not determined (Y, N, ND) in the ❑ for the following statements. If"not determined,"please explain. ❑ The septic tank is metal and over 20 years old*or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND Explain: ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed 08.84 Shannon.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 419 South Main Street, Centerville MA 02632 Property Address Estate of Raymond Shannon C/O Gilmore Rees Carlson & Cataldo Attn: Paul Bishop Owner Owner's Name information is 20 Walnut Street, Wellesley MA 02481 April 15 2008 required for Y p � , every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ distribution box is leveled or replaced ND Explain: ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed ND Explain: C) Further Evaluation is Required by the Board of Health: ® Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CNIR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. 08-84 Shannon.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 419 South Main Street, Centerville MA 02632 Property Address Estate of Raymond Shannon C/O Gilmore, Rees Carlson & Cataldo Attn: Paul Bishop Owner Owners Name information is 20 Walnut Street, Wellesley MA 02481 April 15, 2008 required for Y every page. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: Septic tank is leaking, garage apartment has a single cesspool. System for five bedroom main house consists of a 1000 gal. tank and one 6x6 leaching pit which by town standards will only acommodate three bedrooms. D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than_day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. 08-84 Shannon.doc-08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 15 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 419 South Main Street, Centerville MA 02632 Property Address Estate of Raymond Shannon C/O Gilmore, Rees, Carlson & Cataldo Attn: Paul Bishop Owner Owner's Name information is 20 Walnut Street, Wellesley MA 02481 April 15 2008 required for Y p � , every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): Yes No ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10.000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D, Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 08-84 Shannon.doc•08/06 Title 5 Official Inspection Form.Subsurface Sewage Disposal System•Page 5 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 419 South Main Street, Centerville MA 02632 Property Address Estate of Raymond Shannon C/O Gilmore Rees Carlson & Cataldo Attn: Paul Bishop Owner Owner's Name information is Y A 20 Walnut Street, Wellesley MA 02481 r 15 required for April , 2008 every page. Cityfrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no"as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ❑ ® Were as built plans of the system obtained and examined? (If they were not available note as N/A) ❑ ® Was the facility or dwelling inspected for signs of sewage back up? I ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid,depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ❑ ® Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] 08-84 Shannon.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 15 Co mmonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments wM 419 South Main Street, Centerville MA 02632 Property Address Estate of Raymond Shannon C/O Gilmore Rees Carlson & Cataldo Attn: Paul Bishop Owner Owners Name information is Y 20 Walnut Street, Wellesley MA 02481 Aril 15, 2008 required for p every page. City/Town State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 5 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Number of current residents: Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ❑ No Seasonal use? ® Yes ❑ No Water meter readings, if available(last 2 years usage (gpd)): Sump pump? ❑ Yes ® No Last date of occupancy: Two months prior to inspection. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe): 08-84 Shannon.doc-08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 419 South Main Street, Centerville MA 02632 Property Address Estate of Raymond Shannon C/O Gilmore Rees Carlson & Cataldo Attn: Paul Bishop Owner Owner's Name information is required for 20 Walnut Street, Wellesley A MA 02481 April 15, 2008 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: None Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: 1980+/- Were sewage odors detected when arriving at the site? ❑ Yes ® No 08.84 Shannon.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15 Commonwealth of Mas sachusetts r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 419 South Main Street, Centerville MA 02632 Property Address Estate of Raymond Shannon C/O Gilmore Rees Carlson & Cataldo Attn: Paul Bishop Owner Owners Name information is required for 20 Walnut Street, Wellesley MA 02481 April 15, 2008 every page. Cltyfrown State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): Depth below grade: 1' feet Material of construction: ®cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): 1, Depth below grade: feet Material of construction: ®concrete ❑ metal ❑ fiberglass ❑ polyethylene El other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No ------------------------------------------------------------------------------------------------------------ Dimensions: 8.5' long x 5.2'wide- 1000 gal. Sludge depth: 0 Distance from top of sludge to bottom of outlet tee or baffle Scum thickness 0 Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? Visual. 08-84 Shannon.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 15 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 419 South Main Street, Centerville MA 02632 Property Address Estate of Raymond Shannon C/O Gilmore Rees Carlson & Cataldo Attn: Paul Bishop Owner Owners Name information is 20 Walnut Street, Wellesle MA 02481 April 15, 2008 required for y every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank was half full at time of inspection, observed a stain line at 2/3 capacity. Tank is leaking and has never filled to outlet pipe. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑other(explain): 08-84 Shannon.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 15 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 419 South Main Street, Centerville MA 02632 Property Address Estate of Raymond Shannon C/O Gilmore Rees Carlson & Cataldo Attn: Paul Bishop Owner Owners Name information is 20 Walnut Street, Wellesley MA 02481 April 15, 2008 required for Y every page. City[Town State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank(cont.) Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level.' Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No 08-84 Shannon.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 15 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 419 South Main Street, Centerville MA 02632 Property Address Estate of Raymond Shannon C/O Gilmore Rees, Carlson & Cataldo Attn: Paul Bishop Owner Owners Name information is 20 Walnut Street, Wellesley required for y MA 02481 April 15, 2008 every page. Cltyrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located why: explain w : p Type: ® leaching pits number: Onr 6x6 pit ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Pit was empty at time of inspection with no sidewall stains pit had never had flow due to leaking tank 08-84 Shannon.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 15 ' Commonwealth of Massachusetts r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M ' 419 South Main Street, Centerville MA 02632 Property Address Estate of Raymond Shannon C/O Gilmore Rees Carlson & Cataldo Attn: Paul Bishop Owner Owners Name information is 20 Walnut Street, Wellesley required for Y MA 02481 April 15, 2008 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 08-84 Shannon.doc-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 15 ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments w„ 419 South Main Street, Centerville MA 02632 Property Address Estate of Raymond Shannon C/O Gilmore Rees Carlson & Cataldo Attn: Paul Bishop Owner Owners Name information is 20 Walnut Street, Wellesley MA _ 02481 April 15, 2008 required for y every page. City/rown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Alp\ et Wall 21 32 I 1 22 Commonwealth of Massachusetts r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 419 South Main Street, Centerville MA 02632 Property Address Estate of Raymond Shannon C/O Gilmore Rees Carlson & Cataldo Attn: Paul Bishop Owner Owners Name information is Y A 20 Walnut Street, Wellesley MA 02481 r required for April 15, 2008 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope 23 Surface water ® Check cellar ® Shallow wells Estimated depth to ground water: 15 feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Marsh at rear of property is 6-T lower than bottom of leaching pit. 08-84 Shannon.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 15 Town of Barnstable �p THE l Regulatory Services •AR MBM ; Thomas F. Geiler,Director MASSE Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-8624644 Fax: 508-790-6304 This septic system inspection report was completed by a private inspector who is certified by the State of Massachusetts, Department of Environmental.Protection. Although the Town of Barnstable Health Division received the original/copy of this report; this Division does not warranty the functionality of the septic system in the future not does this Division agree with any technical observation s and interpretations contained within this report. In addition, by receiving this report the Town of Barnstable Health Division does not automatically approve the number of bedrooms listed within this report. The actual number of bedrooms approved at a particular property would-be listed on the"Disposal Work Construction Permit". If you should have any questions regarding this report,please contact the certified Septic System Inspector who conducted the inspection. 05/1-:0/2008 TUE 12: 34 FAX 508 420 3161 Sotheby' s Osterville 2001/017 SY Lh 6joby S INTERNATIONAL REALTY 851 Main Street a OsterAi -- PIA OMS a 31M.428:9115 248 Stevens Street a Hyannis,MA 02601 a 508.775.0900 i FaxTransmission i K. Gene Orloff r' Fax: 508-420-3161 508-957-5563 FofloAWng you'll find _page(s) not including this cover sleet. If received poorly or if incomplete, please notify me. Phone Number 508428-91 IS Fax M : S 20m3161 -mse -Aote: The pages comprising this facsimile transmission contain confidential information from Sotheby's International Realty. This infornititian i y,intended solely for use by the individual or entity named as the recipient hereof_ If you are not the intended recipient,Iae taevare diait:any disclosure,copying,distribution or use of the contents of this transmission is prohibited. If you have received this tran:srnism!ion in aiTor,{tease notify us by telephone immediately so that we may arrange to retrieve this transmission at no cost to you. The ro::cipient r:my request that the sender not send any future facsimile advertisements to a designated facsimile machine or rwltin(as. TO i.i t.uiv of 1i1wre facsimile advertisements from this sender, please call 800.851.9115 at any time on any day of the week It vs prr a:biilk.e d to send this facsimile,in whole or in part,to any third party. Gone Orloff Office:508-428-9115 x563 Office Fa)c 508-42D-3161 Horne Office:508.957-5563 .I; Cellular 508-364-2907 ErtlaiC gene.orlofifsothefsysrealty eom :t 35/20/2006 TOE 12: 34 FAX 508 420 3161 Sotheby' s Osterville ID002/017 Town of Barnstable Barnstable ;�N ,'o���� 0L Regulatory Services Department `a Public Health Divislon 200 Main Street,Hyannis MA 02601 2007 Office: 508-962-4644 Thomas F.Geiler,Director FAX: 503 790-6304 Thomas A.McKean,CEO April 29,2008 i Raymond Shannon 150 Ledgewood Road Dedham,MA 02026 i ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE,TITLE 5 The septic system located at 419 South Main Street,Centerville MA was last inspected on Aloril 1.5,2008,by Patrick O'Connell, a certified septic inspector for the State of iWlassachusetts., The inspection of the septic system showed that the system"Needs Further Evaluation" Mader the guidelines of 1995 TITLE 5 (310 CMR 15.00)due to the following: Septic tank is leaking. ® Garage apartment has a single cesspool A Insufficient system capacity for number of bedrooms. '11 ou are ordered to repair or replace the septic system within Two(2)years from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future 'e:1forcement action. PER ORDER OF THE 13 OF HEALTH ' c ean,R.S., CHO A.e 1c®"$he Board of Health CERTIFIED MAIL#7006 2150 6002 , 72 ` 1038 7251 Q:\SEPT1C`T.etters Septic Inspection Failuresl419 South Main Street.doc 05/20%2006 TUE 12: 34 FAX 508 420 3161 Sotheby' s Osterville (DO03/017 a�nu�ets� ®ern®P�t►aalth of glass �Ct�®11 F®r1'V1 01 g Assessments -- � u ,subsurface sewage Disposal System Form Not for Volun ary u=_ 419 south Main Street,Centerville MA 02632 Address property a mond Shannon CIO Gilmore,Rees,Carlson&Cataldo Attn: Paul BiIs15 2008 Estate of R MA 0248�1 owner's Name Date of Inspection i iwril:i VVellesle State Zip Code rjivrnati<an is 20 Walnut Street, p;olt-d'rcr Chy�own not be altered in any nn-TJ p�,it,a. ®ctton forms may Inspection results must be submitted on this form.Insp way. frriibortlseet , *inn IP o- �Ganerai informat � —� i ^il�t®n y'ilting Dill .I.DUAS ur.,thla 1 inspector; t:TJ'sY{ UI:EfT,61LUif ;3rly tb,s tat,key 'Connell ;,� {tyve Vol!" patricic M. O cc t or-do rr�4 Name of Inspector ghe return c,�® tiC Ins ection Services Co. w, Company Name �.��. 189 Cammeb Road 02648 Company Address MA Zip Code M arston Milts State �a� City(fown License Number 508-428-1779 'telephone Number CeP$IflCatt®G1 ection is 1 certify that t have personally inspecte d the sewage disposal system Of thedinspection�;hehnsp ex per in the proper function an t aSection 3qp Of ion reported below is true,accu d to aand complete as of the time urs informal training an stem,In p was performed based on my roved sY sewage disposal systems.t am a®EP app `title 6(3`10 CMR 16,000).The system: ® Fails j] Conditionally Passes [] Passes Authority C the Local Approving Needs Further Evaluation by fc. A Til 15,2008Q/ Date Board Approving Authority Ins ecto�s Signature r✓ Inspector shaft submit a copy of this inspection report to the system t stem Insp this inspection.if thes�esn owne�hall submit the r r The system within 30 days of completing ector and the sy owns i of Health or DEP) d or greater,the insp The original should be sent to the system has a design flow of 10,000 ion al office of the DEP• roving authority report to the appropriate regional livable,and the approving l and copies sent to the buyer,if appco at the time of inspection and erform n the er�the futture us der er the co conditions err►will p s con s st 4 ««�*ThiS report only describe at that time.This inspection dogons of o address how t e . the same or different Il Tilte 5 01faw inspection Form:Subsurface sewage OisD�al System•pega t e. }5 45 O,.t4 She'nnon.doc•08106 i Ii5/2.0/2008 TUE 12: 35 FAX 508 420 3161 Sotheby' s Osterville 2004/017 Cowan®��ealth of Massachusetts ®n ®rgn .�, iciai Inspect 41� 5 ® Assessments Subsuirface Sewage Disposal System Form-Not for Voluntary _dG � G 1r ��. g South Main Street,Centerville MA 02632 =- 41 k Address k. property Rees,Carlson&Cataldo Attrr Pau{Bisho Estate of Ra mond Shannon CIO Gilmore, MA 0248! 1 April 15,2003 ;caner Ovune>'s Name Zip Code pate of inspection �,!'ei+rrail��n is 20 Walnut Street,Wellesley state :a3c{cNared for Cily/Town i B. certifacatiOn (cont.) inspection Summary:Check A,B,C,D or E!always complete all of Section D A) System Passcs. of the failure criteria described that any 1 have not found any information is 304icates exist Any failure criteria not evaluated are ❑ in 310 CMR 15.303 or in 31 { indicated below. Comments: i �) System Conditionally Passes: f the replacement or repair,as approved by components as described in the `Conditional Pass' section need to e F ., 4 ® One or more system stem,upon completion o replaced or repaired.The system- statements.if"not the Board of Health,will pass. Y N ND)in the❑for the following Answer yes,no or not determined( , {ease explain. tank(whether metal or not)is determined,"p ears old*or the septic The septic tank is metal and over: Y laced with a contplying septic tank as ❑ exhibits substantial infiltrationor exfiltration or tank failure is imminent. structurally un inspection if the existing tank is replaced System will pass approved by the Board of:Hea{th. sound,not leaking and if a Certificate • meta{sep tank is less than 20 years old is available. A tic tank wilt passtin pection if it is structurally of Compliance indicating that NO Explain! 1: the the stem w ill c reak out or high static water i venl distribution distribution ox•syoyj�stem 'due e backup or b ® Observation of se wag or due to a broken,settled or uneven ' to broken or obstructed pipe(s)re{of Board of Health): pass inspection if(with approval ® broken pipe(s)are replaced tl ® action Form:Suhsurface SeWaBe Oisposel o SYslam•pago 2 of ti obstruction is removed Tills 5 0diciei inap { GB.34 Shennon.dx•08f06 ?5/20/2008 TGE 12: 35 FAX 508 420 3161 Sotheby' s Osterville 2005/017 ab i�c�tnBn®nwealth of MassachusetUl* Form � ®mcial insp��t for Voluntary As PIN; = �ILI stem Porrt- y :4 Disposal Sy + �;ubsurface Sewage Ot Centerville MA 02632 South Main Street, -� ��•°pe�y Address Gilmore Rees Carlson&Cataldo Attn Paul B►sho mood Shannon CIO Aril 15,2d08 Estate of Ra 02401 neti s !l Zip 0 Date of tnsPectio^ ellesle State 5,0 Walnut Street,W guieedlor � /town �o Certification (cont.) �) system Conditionally Passes(cont.): distfibutiO r box is leveled or replaced i No Explain: more than 4 times a y ear due to broken or obstructed pipe(s)•The ' stem reGuired put n 1, approval of the Board of Health): ❑ The system action if(with system will pass insp ❑ broken pipe(s) are replaced ® obstruction is removed t4D Explain: i ` t Required by the Board of Wealth: ®r Evaluation is b the Board of Health in order to determine if C) Furth reqwire further evaluation Yor the environment. Conditions exist which protect public health,safety ubllc heal4:h, the system is failing p alth determines in accord vudl p tact p CMR he System is not functioning in a manner whrc 4 gystem will pass unless Board of e 15.303(�n(d theat tI environment: safety Cesspool or privy is within 50 feet of a surface water vegetated wetland or a salt marsh ❑ ve et is within 5d feet of a bordering g liar,if any) ❑ Cesspool or privy ub9ic health, ` and Public wrote is the p ' is functioning in a manner that p 2, System will fail unless an a®Deed of Wealth determines that the system stem (SAS)and the SAS is within safety and environment: absorption sY The system has a septic tank and soil absorp to a surface water supp1- a public water 1 ❑ 10 0 feet of a surface water supply or tributary stem has a septic tank and SAS and the SAS is within a�fee of a private water ❑ The system supply• tic tank and SAS and the SAS is within has a septic set System.page 3010 ® The system subeunace sewage D1sPo supply well. r,rs 5 01re1a11nspedionfey: i USEd Shaonon.doc•°Sf08 I 05420/2006 TUE 12: 35 FAX 508 420 3161 Sotheby' s Osterville 2006/017 F . ®'gremonwealth of Massachusetts .®n Form T�fle ®ffecralInspect� . _• Assessments low' - stem Form Not for Voluntary H, ,- { �Y-._ ; F s Subsurface S®wage Disposal y ' f5� t . ` ry ;; . v . ? 419 South Main Street,Centerviile MA 02632 isho Address Property Estate of Ra mond Shannon CIO Gilmore,Rees Carlson 8�Cataldo Attn.Paul 8I 15,2008 Owner's Name MA 02481� 3adn5r Zip Code Date of inspection Ifcr�+ailan is 20 Walnut Street,Well esle state �uir4d fa?r City/Town -:Etzry page. C Further Evaluation is Required by the Board of tiealth(cont.): septic tank and SAS and the SAS is Tess than 100 feet but 50 feet or t] The system has a P l well"" more from a private water supply t Method used to determine distance: performed at a DEP certified laboratory,for coliform ^�This system passes if the well water analysis, p A copy of the analysis must be trogen and bacteria indic ates absent and the presence of am tareitriggered nitrate nitrogen is equal s or less than 5 ppm,provided that no other failure criteria attached to this form. 3. Other: for five apartment has a single cesspool,systemtndards will ornly acommadate Septic tank is leaking,garage aP it which by town consists of a 1000 gal•to and one 6x6 leaching p three bedrooms- Systems: t F 3{ r i i i ' ®� System Failure Criteria Applicable to All systems: j ( You must indicate "Yes"or"No"to each of the following for all inspections: Yes No or system component due to overloaded or Backup of sewage into facility ® clogged SAS or cesspool round or surface waters Discharge or pono the surfac Of ding of effluetSAS or cesspoolhe g [] ® due to an overloaded or clogged Static liquid I evel in the distribution box above outlet invert due to an overloaded ❑ ® or clogged SAS or cesspool + cesspool is less than 6"below invert or available volume is less ` Liquid depth in cessp ❑ clogged or ® than_day Required pumping more than 4 times in the last year td®T due to pumped'. .° ❑ obstructed pipe(s).Number of times p p round water elevation. ❑ ® Any portion of the SAS, cesspool or privy is below high 9 f ss ool or privy is within 100 feet of a surface water supPiY or Any portion of ce p 4 ❑ ® tributary t0 a surface water Supply- a SubsuAace Sewags.Disposal System•Pr®e 4 of r5 y Tills 5 official lnsPa�Dn l i!9a34 Shannen.doo•W00 i' 05/s:0/2008 TUIE 12: 35 FAX 508 420 3161 Sotheby' s Osterville 12007/017 9�®Mraonwealth of Massachusetts official Inspection Form _ � Assessments �;� _ " To IL ,��T � posal System Farm Not for Voluntary ( _ �r Subsurfa�Oqew�a. 419 Soutenterville MA 02632 ttrr paui Bish0 property Address O Gilmore,Rees,Carlson&Cataldo A Estate of Ra mond Shannon C 02481 A rii 15 2005 t�;ref Owner s NameM`_ Zip Code Date of inspection n5ta�nnaChon ss 2f)VVainut Street,Welles{e state nertulred f0l, ill own I �o ���°tafocation (cunt.) j able to All Systems(cons ®) System Failure Criteria APP tic Yes No Public weft. n onion of a cesspool or privy is within a Zane 1 of a Any P is within 50 feet of a private water supply Any portion of a cesspool or privy ' 0 feet � well his han Any portion of a cessp ool or privy is less than 100 feet but greaterter quality ana►ys5s.(T ❑ ® private water supply well with no acceperformed at a D�cerle-watified z. from, p sis,p resence System passes if the well water aaaly ual to or less than 5 Ppm9 iaboratorY,for fecal coliform bacteria indicates is eq absent and t® the analysis of ammonia nitrogen and nitrate nitrogen Bred.A COPY provided that no other failure criteria are trigg and chain of custody must be attached to this form The system is a ill serving a facility with a design flow of 2000gpd- ® ® 10,000gPd that one of MOP fails.The e system falls.11, determined R 15.303 therefore the system what Will e of the above be s ❑ criteria exist as described in 310 C system owner should contact ehe Board of Health to determine necessary to correct the with a To be considered a large system the system must serve a facility E) Large Systems: d to 16,000 gpd 0 gP in addition to the design flow of 10,00 For large systems,you must indicate either"yes"or"no"to each ofthe.followin9, i questions in Section D. Yes NO water supPW the system is within 400 feet of a surface drinking ❑ ❑ to a surface drinking water supply the system is within 200 feet of a tributary Interim Wellhead Protection ❑ Zone 11 of a public water supply well the system is located in 31 itrogen sensitive area ® ❑ Area—iWPA)or a mapped is considered aerat irtof any largt= es"to any question in Section E the systemupgrade an the 1 stem has failed.The owner or op ' t if you have answered'Y r or answered"yes"In Section D above the large sY d a s} nificant threat under Section Sn em ovine f§ridouid Section appropriate9 system considered 9 system in a of the Departm ntMR 15.304.The Y regional office 'rift5 ot5etat I-pardon subsuAace Sewage Disposal System Palle Sol 1E 08.84 shannon.doc•O8f08 'i 05l,10/'2008 TUE 12: 36 FAX 508 420 3161 Sotheby' s Osterville (DO 08/017 k Commonwealth of massachusetts CtlOn Form ®fftc�a� lrisp� Assessments j ��1 e Disposal System Form-Not for Voluntary a eD p V !Subsurface Sew 8 40 44g South Main Street,Centerville MA 02632 properW Address hannon C10 Gilmofe Rees,Carlson&Cataldo Attn:Paul Bi'�5 2008 instate of Ra rnontl S 02481 A ®wner's Name MMM Z;p Code Date o4{nspection N.�nn er Welies, State nioiialatlort IS 20 Walnut Street, re'pirad t�sr CNITown atf�1�J pug® c checklist es' or"no"as to each of the following: t have been done. f You must indicate`Y } check if the ollowing provided by the owner,occupant.or Board of Health ' Yes No pumping information was pro previous two weeks? ❑ ® re anyof the system components pumped out in the ❑ ® We week period? previous two art of I stem received normal flows in the p stem recently or as p ❑ � Has the system e Have large volumes of water been introduced to the system mined if they Were not ® this inspection? stem obtained and exa ❑ Were as built plans of the sy ❑ available note as NIA) inspected for signs of sewage back up? 1 ❑ Was the facility or dweiling Pe Was the site inspected for signs of break out? ® ❑ stem components,excluding the SAS,located on site? ® ❑ Were all system o erred,and the interior of the tan i tic tank manholes uncovered, p ® ❑ Were the septic and depth of scum9 ted far the condition of the bans udgeees,material of construction, inspected depth of liquid,depth provided with dimensions, p stems? Was the facility owner and occupantCe o{subsurface sewage disposal sy ❑ information on the proper maintenan tion gystem(SAS)°n the site has a The size and location of the Soil Absorp a been determined based on: tan at the Board of Health. ❑ Existing information.For example,a p is at issue Of the failure criteria related Part c peterminead i toe distla(if eas any t310 CMR 1 ® ❑ apgrox{mon k ft �' Tile 5 o1♦iciel lnsp ecllon Form;SuZsukface Sewage 0lsposel System �aBe 6'sl Ca434 shannon.doc•0806 ! l 05/20/2008 TUE 12: 36 FAX 508 420 3161 Sotheby' s Osterville 2009/017 t Commonwealth of Massachusetts -y` - Title 5 Official Inspection Form `' a t e Sewage Disposal System Form-Not for Voluntary Assessments Subsurface g p Y • 419 South Main Street,Centerville MA 02632 Property Address Estate of Raymond Shannon C/O Gilmore Rees Carlson &Cataldo Attn: Paul Bishop Owner Owner's Name it'Ihitrn,idon is 20 Walnut Street Wellesley MA 02481 April 15,2008 rixulmd for j eaff:ry p;:tge. City/Town State Zip Code Date of Inspection j ®o System Information i Residential Flow Conditions: Number of bedrooms(design); 3 Number of bedrooms(actual): � 5 ' DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 30 _ x Number of current residents: Does residence have a garbage grinder? Yes ® No a Is laundry on a separate sewage system?[if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ❑ No Seasonal use? ® Yes ❑ No Water meter readings,if available(last 2 years usage(gpd)): Sump pump? ® Yes ® No ;I Two months prior r Last date of occupancy: to inspection. 1 Commerclallindustrial Flow Conditions: Type of Establishment. } Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft.,etc.): Grease trap present? ❑ Yes [] No Industrial waste holding tank present? ❑ Yes [] No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ® No Water meter readings, if available: Last date of occupancy/use: Date Other(describe): 0844 Sfiannon.doe•08106 TOM 5 official Inspection Form:Subsuifew Sewage Disposal System•Page 7 or 15 t 05 20/2008 SUE 12: 36 FAX 508 420 3161 Sotheby' s Osterville 0010✓01 Commonwealth of Massachusetts f 0R _ : Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 419 South Main Street,Centerville MA 02632 Property Address Estate of Raymond Shannon C/O Gilmore Rees Carlson&Cataldo Attn:Paul Bishop t5wnar Owner's Name iriforesu('Ilan Is 20 Walnut Street,Wellesley MA 02481 April 15,2008 � requiredfor evary page. City/Town State Zip Code Date of Inspection D. System Information (cont.) I ' General Information I Pumping-Records, Source of information: None Was system pumped as part of the inspection? ❑ Yes ® No If yes,volume pumped: gallons How was quantity pumped determined? Reason for pumping: r Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool j ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no)(if yes,attach previous inspection records, if any) Innovative/Altemative technology.Attach a copy,bf the current operation and. j maintenance contract(to be obtained from system owner) ® Tight tank,Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components,date installed(if known)and source of information: 1980+/- i Were sewage odors detected when arriving at the site? ElYes ® No _ 7 Page B o915 US-W 3hartnon.doe•OBM Title 6 Official lnspeatton Form:Subsurface sewage Disposal system• 05/20/2008 TUE 12: 36 FAX 508 420 3161 Sotheby' s Osterville 2011/017 i Commonwealth of Massachusetts Title 5 Official Inspection Form . Assessments Form Not for Voluntary Assessm Disposal Sy stem Subsurface Sewage Dtsp Y • ; ='_fir 419 South Main Street,Centerville MA 02632 Property Address Estate of Raymond Shannon C/O Gilmore,Rees Carlson&Cataldo Attn:Paul Bishop Owner Owner's Name q:.informa'";on IS 20 Walnut Street Wellesley MA 02481 April 15 2008 requ[redl far state State Zip Code Date of Inspection eyvr-ry page, D. System Information (cont.) li Building Sewer(locate on site plan): j 1 i Depth below grade: feet Material of construction: ®cast iron ®40 PVC ❑other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints,venting,evidence of leakage, etc.): I - . Septic Tank(locate on site plan): } Depth below grade: feet Material of construction: _ concrete ❑metal ❑fiberglass ❑polyethylene ❑other(explain) If tank is metal,list age: years r Yes ❑ No is age confirmed by a Certificate of Compliance?(attach a copy of certificate) --------------------------------- 85 long x 5 2'wide-1000 gal. j Dimensions: ! 0 Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle 0 Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle t Visual. How were dimensions determined? • Title 5 Official Inspection Form:Subsudsw Sewage Otsposef System QE-34 Shnnnon.doc 6g1De page 9 or i5 l j t 05/2012008 TUE 12: 36 FAX 508 420 3161 Sotheby' s Osterville 20 12/017 k i Commonwealth of Massachusetts =y Title 5 Official Inspection Form i e Subsurface Sewage Disposal System Form-Not for Voluntary Assessments _ --_ t I a 419 South Main Street,Centerville MA 02632 Property Address Estate of Raymond Shannon CIO Gilmore Rees Carlson&Cataldo Attn: Paul Bishop Q7uurter Owner's Name 3ttbonnatian is _20 Walnut Street Wellesley MA 02481 April 15 2008 real aired for State Zip Code Date of Inspection eb'ery Clty/rOWn I ' i De System Information (font.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage, etc.): Tank was half full at time of inspection,observed a stain line at 2/3 capacity.lank is leaking and has never filled to outlet pipe. Grease Trap(locate on site plan): f Depth below grade: feet I s; Material of construction: i ©concrete ❑metal Elfiberglass ❑polyethylene ®other(explain): i I Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date e+ Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert, evidence of leakage,etc.): 4 ;i . �, Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑concrete ❑metal El fiberglass polyethylene ❑other(explain): 68.84 Shannon.doC•08106 Title 5 official Inspection Form:Subsudars Sewage Disposal System•Page 10 rrf 16-. i 05/20/'2008 TUE 12: 37 FAX 508 420 3161 Sotheby' s Osterville 2013/017 Commotmealth of Massachusetts Title 5 Official Inspection Form t Subsurface Sewage Disposal System Form Not for Voluntary Assessments I;; 8 419 South Main Street, Centerville MA 02632 - �" Property Address Estate of Raymond Shannon C/O Gilmore,Rees,Carlson&Cataldo Attn: Paul Bishop f yiner owner's Name I Irildr tadiun i,e 20 Walnut Street,Wellesley Wvsry MA 02481 April 15,2008 _ ' ry p a�e lje. City/Town State Zip Code Date of Inspection i D. System Information (cont.) Tight or Holding Tank(cont.) 3 Dimensions: Capacity: gallons i Design Flow: gallons per day Alarm present: ❑ Yes ❑ No t Alarm level: Alarm in working order: ❑ Yes ❑ No t Date of last pumping: Date Comments(condition of alarm and float switches, etc.): I � ' s "Attach copy of current pumping contract(required). Is copy attached? ® Yes ❑ No Distribution Box(if present must be opened)(locate on site plan): $ Depth of liquid level above outlet invert t Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover,any evidence of leakage into or out of box, etc.): ; r t i Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ® No Alarms in working order. ❑ Yes No 0&U.Sllennon.doc=COM Tille 5 OKciel Inspection Form:Subsurfata Sewage Disposal tam•Page ti of t5 Sys 0/2008 TUE 12. 37 FAX 508 420 3161 Sotheby' s Osterville 0014/017 Commonwealth of Massachusetts I= Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments f , 419 South Main Street, Centerville MA 02632 j Property Address Estate of Raymond Shannon CIO Gilmore Rees Carlson&Cataldo Attn: Paul Bishop Cumer Owner's Name r intor matlon is 20 Walnut Street,Wellesley MA 02481 April 15 200t3 r+'rt;l�lrt et`or State Zip Code Date of Inspection every dale. Cityfrown j D. System tnfonnation (cont.) I 3 Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): i ( Soil Absorption System(SAS)(locate on site plan,excavation not required): a If SAS not located, explain why: Type: Onr 6x6 pit i ® leaching pits number: ' ❑ leaching chambers number: ® leaching galleries number: ❑ leaching trenches number, length: i ❑ leaching fields number,dimensions: ® overflow cesspool number: -' li ❑ innovative/alternative system i Type/name of technology: I �f z Comments(note condition of soil, signs of hydraulic failure, level of ponding,damp soil,condition of vegetation, etc.): :. s Pit was empty at time of inspection with no sidewall stains, pit had never had flow due to leaking tank. j 0&C-4 Sha"mon.Boc•MOBTitte s official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15 t . i !A 05/.20 2.308 TUE 12: 37 FAX 508 420 3161 Sotheby' s Osterville 2015/017 r Commonwealth of Massachusetts Title 5 Official Inspection Form t Subsurface Sewage Disposal System Form Not for Voluntary Assessments `i +i� I 419 South Main Street,Centerville MA 02632 Property Address 1 Estate of Raymond Shannon C/O Gilmore Rees,Carlson&Cataldo Attn: Paul Bishop r Owner Owner's Name iettasm t;urn is 20 Walnut Street,WellesleyMA 02481 April 15 2008 r re a}drzrl'`ar state Zip Code Date of Inspection i evs•ry fi.i;e. Citylrown D. System Information (coot.) l I � Cesspools(cesspool must be pumped as part of inspection)(locate on site plan): Number and configuration ` Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool 1 Materials of construction Indication of groundwater inflow ❑ Yes No Comments(note condition of soil, signs of hydraulic failure,level of ponding,condition of vegetation, etc.): Privy(locate on site plan): 7 Materials of construction: Dimensions Depth of solids _ Comments note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation, etc.): 08-:9 Shannon.Coe=08/OB Title 5 OfTraet Inspection Forth:Subsurface Sewage Diaposei Syslem Page 13 0°15 G5/20/2008 TUE 12: 37 FAX 508 420 3161 Sotheby' s Osterville 0016/017 Commonwealth of Massachusetts R. Title Se Official Inspection Form -' ' Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ;;i� 419 South Main Street,Centerville MA 02632 Property Address Estate of Raymond Shannon C/O Gilmore, Rees Carlson&Cataldo Attn: Paul Bishop nwi ar Owner's Name Ini'orrnation is 20 walnut Street Wellesley MA 02481 April 15 2008 regain:d fcr State Zip Code Date of Inspection fuerir pane,. City/Town v 's D. System Information (cost.) Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet, s Locate where public water supply enters the building. i i a \ a \ \ \ \ \ \ \ ♦ \ Y e a j . ♦ \ \ ♦ a \ \ a \ a \ \ a a \ f .j`mi'�r YJ\larYla! i Y Yr \r � f' - Y ♦ a \ \ \ \ \ Y a \ \ \ a ♦ \ 6r et Wall !r a ♦ \ \ \ Y \ \ a a f r J ! J J J ! r r r ! r �N i 21 32 d3 � eraaaa ♦ \ a \ a \ aa J q)q) Yyt,M1 \ \ a \ aa \ aa \ a \ \ a a \ a I / J rr /.. J 1. \ • '% aaa \r\r\r\/\Ja/i\/ / / i _� , aaaa \ \ a ♦ ♦ a \ \ \ I � 22 fi :35�• �t 05/20/2)08 TLIE 12: 37 FAX 508 420 3161 Sotheby' s Osterville 12017/017 Commonwealth of Massachusetts � _� Title 5 Official Inspection Farm'' 1At9 _ low' tL H M Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 419 South Main Street,Centerville MA 02632 s Property Address Y Estate of Raymond Shannon C/O Gilmore Rees Carlson &Cataldo Attn:Paul Bishop Oulllar Owner's Name ia`rorinati�-n is 20 Walnut Street,Wellesley MA 02481 April 15 2008 _ 'et uiTed 1'1)r evcrt page, City/Town State Zip Code Date of Inspection I i D. System Information (cont.) i Site Exam: ® Check Slope F ® Surface water ® Check cellar f ® Shallow wells 15 Estimated depth to ground water: feet t Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record Y If checked,date of design plan reviewed: Date I ® Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: I t 4 ® Checked with local excavators, installers-(attach documentation) 4 . ❑ Accessed USGS database-explain: You must:describe how you established the high ground water elevation: ' Marsh at rear of property is 6-T lower than bottom of leaching pit. I F 9 ' ' t 013:94 Page 16 of'IS Sliennon.dac•08108 Tltte 5 Offival Inspetllon Form:Subsurface Sewage Disposal System• T Commonwealth of Massachusetts . W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments wM 419 South Main Street - Property Address . Michael Kelley Owner Owner's Name information is Centerville Ma 02632 1/6/14 required for every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end.of the form. - Important: A. General Information When filling out forms on the computer,use: .. (� y I 5�5 onlythe tab ke 1. Inspector: to move your ... Ricky L.Wright. I . cursor-do not use the return Name of Inspector key. B&B Excavation Company Name 14 Teaberry Lane . Company Address Sandwich Ma. 02644 re"0fl City/Town State Zip Code (508)477-0653 S14595 Telephone Number License Number B. Certification certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the.inspection. The inspection was performed based on my training and experience.in the proper function and maintenance of on site . sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fes ' o _. .. _. Needs Further Evaluation by the Local Approving Authority cry., _..1/6/1 4 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Boerd of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design.flow of 10,000 gpd or greater;the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer,.if.applicable, and the.approving.authority. ... ****This report only.describes conditions at the time.of inspection and under the conditions of use at that time..This inspection does not address how the system will perform in the future under the same or different conditions of use. � ( 21 � IH t5ins•3/13 Title 5 Official Inspection VFormbs Sewage Disposal System Pagel of 17 i Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 419 South Main Street Property Address Michael Kelley Owner Owner's Name information is required for Centerville Ma 02632 1/6/14 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, IN, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 419 South Main Street Property Address Michael Kelley Owner Owner's Name information is required for Centerville Ma 02632 1/6/14 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 i Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 419 South Main Street Property Address Michael Kelley Owner Owner's Name information is required for Centerville Ma 02632 1/6/14 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal vi h no other failure criteria are triggered. A co of the analysis must to or less than 5 ppm, provided that gg copy y be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than day flow l5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 419 South Main Street Property Address Michael Kelley Owner Owner's Name information is required for Centerville Ma 02632 1/6/14 every page. CitylTown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either`yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA)or a mapped Zone II of a public water supply well If you have answered 'yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts _ F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 419 South Main Street Property Address Michael Kelley Owner. Owner's Name information is required for Centerville Ma 02632 1/6/14 every page. = City/Town State Zip Code - Date of Inspection C. Checklist .. Check if the following have been done:.You must indicate"yes" or"no"as to each of the following: Yes. No El M Pumping Information was provided by the owner, occupant, or Board of Health ❑ Z Were any of the system components pumped out in the previous two weeks? Has the system received normal flows in the previous two week period? Have large volumes of water been introduced to the system recently or as part of ❑ ® this inspection? Were as built plans of the system obtained and examined?(If they were not ® El available note as N/A) ® E] Was the.facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑. . Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? Was the facility owner(and occupants if different from owner) provided with ❑ ❑ information on the proper maintenance of subsurface sewage disposal systems? The size and.location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® Determined in the field(if any-of the failure criteria related to.Part C is at issue El approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential.Flow Conditions: Number of bedrooms(design):: 5 Number of bedrooms (actual):: 5 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 550 t5ins•3/1& Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 419 South Main Street Property Address Michael Kelley Owner Owner's Name information is required for Centerville Ma 02632 1/6/14 every page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?(Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ® Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d n/a 9 ( Y 9 (gP ))� Detail: Sump pump? ❑ Yes ® No Last date of occupancy: current Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 419 South Main Street Property Address Michael Kelley Owner Owner's Name information is required for Centerville Ma 02632 1/6/14 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ❑ No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 419 South Main Street Property Address Michael Kelley Owner Owner's Name information is required for Centerville Ma 02632 1/6/14 every page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 1000 gal tank 25 years est. 1500 gal tank and leaching upgraded in 2008. Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 2 feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: >20 feet Comments(on condition of joints, venting, evidence of leakage, etc.): At time of inspection building sewer appeared to be in good working order no sign of leakage. Septic Tank(locate on site plan): Depth below grade: 1 feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 gal. Sludge depth: 6" t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 419 South Main Street Property Address Michael Kelley Owner Owner's Name information is required for Centerville Ma 02632 1/6/14 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 31" 4" Scum thickness Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 15" How were dimensions determined? scour stick Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): At time of inspection septic tank appeared to be in working order,Tees present no sign of back- up.Liquid level equal with outlet invert. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form_ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M 419 South Main Street Property Address Michael Kelley Owner Owner's Name information is required for Centerville Ma 02632 1/6/14 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 'M 419 South Main Street Property Address Michael Kelley Owner Owner's Name information is Centerville Ma 02632 1/6/14 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert 0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): At time of inspection d-box appears to in working order no sign of deteration, or carryover. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS)(locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 i Commonwealth of Massachusetts W Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 419 South Main Street Property Address Michael Kelley Owner Owner's Name information is required for Centerville Ma 02632 1/6/14 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 4-500 gal ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): At time of inspection leaching appears to in working order no sign of hydraulic failure.Leaching was dry at time of inspection. Cesspools (cesspool must be pumped as part of inspection)(locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 419 South Main Street Property Address Michael Kelley Owner Owner's Name information is required for Centerville Ma 02632 1/6/14 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts . . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 419 South Main Street Property Address Michael Kelley Owner Owner's Name - information is required for Centerville Ma 02632 1/6/14 every page. City/Town - - State Zip Code Date of Inspection- D. System Information (Cont.) - Sketch Of Sewage.Disposal System: Provide a view of the:sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes.below: hand-sketch in the area below_ ❑ drawing attached:separately m ¢ , CBI-5Yb' /g2-11'p" !32•So` _.. W. t33.47�- Ay ►9 REAR _. 2 , gs• Ns' s A. 00 Al :137 s:7' a GgRA6E'.. i t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M 419 South Main Street Property Address Michael Kelley Owner Owner's Name information is required for Centerville Ma 02632 1/6/14 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: >144" feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 7/24/08 Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers -(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Plan on file Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments wM 419 South Main Street Property Address Michael Kelley Owner Owner's Name information is required for Centerville Ma 02632 1/6/14 every page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file I t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 LOCLQTION qf\ SEW&CxE PERMIT UO. VILLAGE IMIST&LLER S U&ME ADDRESS BUILDERS 1.1 Q MF- ADDRESS DI,TE PER"VT ISSUED DATE COMPLI W-ACE ISSUED : T 3!HIV 1 4 1 i P t 1 f T No.............. Fint THE COMMONWEALTH OF MASSACHUSETTS BOARD F HEALTH /. .......OF.... .. .�. �( Application -for Uhipoiittl Worko Tomitrnrtion Vrrniit Application is l ereb `ma or a Permit to Construct ( ) r Rep r an ddj' ual Sewage Di posal t System at ° ��~~ 2 � l'h%(p— 9.4. 011_ ------------- ocation-Address or Lot No. 3 = ........--•-••--•--•-----------------------------••----•-.....-------•------------................ Owner Address W Installer Address Q Type of Building Size Lot____________________________Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Gam, Other—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( ) a' Other fixtures W Design Flow............................................gallons per person per day. Total daily flow----------7.................................gallons. WSeptic Tank—Liquid capacity------------gallons Length---------------- Width................ Diameter......:......... Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area--------------.-----sq. ft. Seepage Pit No--------------------- Diameter____________________ Depth below inlet.................... Total leaching area.--_..__-_----__sq. ft. z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by--------- --•--•--••--•-•-•------------------•--•--••-----••-------------- Date---------------------------------------- Test Pit No. 1----------------minutes per inch Depth of "Pest Pit-------------------- Depth to ground water-..--__.--.--._-.-_--- (� Test Pit No. 2----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water.-._._.__---.---_----__. a -------------•--------------------•-------------:.....-------•---•--•-------------------••----•-----.....................-........... ................. 0 Description of Soil----------------------------------------------------------------------------------- --------------------------------------------------------------------------•--------- x W . --------------- x ----------------------- ------------------------------------- ----------------------------------------------------- U Nature P atrs Alterttio s—Answ wh lappl' bje._._ __�_ _... _A.1..... ._.--__---_ -- ----- -- --------' 444-- -��---- --� '� tY.... ------------------------------------------------------------------------------------- �__ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article NI of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has een 'ssued b the board p h alt �f Signe ......... -• - - Date ApplicationApproved By------------------------------------ .....................-------------------------------------- Date Application Disapproved for the following reasons:.......................................... -••----------------•--....------------.._.....---••-•----------- .................................................. -•----•---------------•-----------•---...-----•-------------•---•------------...•----•_..__......-----------.--•--•---------......------............ Date PermitNo--------------------------------------------------------- Issued.........................................----•-•--•---• Date r ' ti �J I THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH , f �rrtifirttfr rrf f�rrnt�littnr.r r - .: THIS IS TO CEPl'I That the IndiAdual Sewage Disposal System constructed ( ) or Repaired ( � •` .. by ` ------------------------------------------------ -- ----------------------------•------------ /Ifnstal�er / i_./y_ i L at.-••------Y ---- :-••- I -e 7, ��� r �'t�r,�fs�� �-- — :---•----- has been inst" ed in accordance with the provisions of Article XI of The State Sanitary Code as described in the application or Disposal Works Construction Permit No----------------------------------------- dated.....------- :-..f!--��'.._._______. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE..................( - 1 ......................... Inspector Fes/ ••-•--•-= t > THE COMMONWEALTH OF MASSACHUSETTS ~� BOARD OF HEALTH.-, 7 ` NO.. ``� lt. FEE-...... ........... i� >a tt� park #ru rlion Vrrtttit Permission is hereby granted ?�� 1 --------------- -----------------------------------•- to Construct-( ) or 13&--pai (/an Individual Sewage Disposa''System w f at No------ <��r = z,�.{��r= -o=------. _ �U{'r-.�- - -- .� . treet _ as shown on th application for Disposal Works Construction Permit�To----.--- ---- J-- Dated------ q- � ........ ¢------.-.. 7 I rF3oard o H alth { -- DATE--- ------------------------------------------------ FORM 1255 HOBBS & WARREN. INC.. ,PUBLISHERS No..-------•-------•C FEx.....:37................ THE COMMONWEALTH OF MASSACHUSETTS BOARD 9F HEALTH 7�, LJ......0 F.. .................... Apphratinn -fur Bhipaoat Works Tomitrurtion Vrrniit Application is hereby made tor a Permit to Construct ( ) or Repa (°A an- ual Sewage Disposal / System at: "' _ (�``�"� �°L 2_�d�.. `�,C/` _ ��• �u�•.,, (,y Y rrf . ............................. •--- ='' »� i-..---•.......................-------- ......... Location- or Lot No. . ......................... •--•-••-••-------•------•---------•---.....-•-----....-...-•--------------•-._..__.._.....-•---•.. W / Owner Address •-------------------------•••-•-•••---•.... Installer Address UType of Building Size Lot____________________________Sq. feet Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons..______---__________-__---- Showers ( ) — Cafeteria ( ) PaOther fixtures ............................................................................... ------- W Design Flow............................................gallons per person per day. Total daily flow.........................................---gallons. WSeptic Tank—Liquid capacity------------gallons Length................ Width................ Diameter................ Depth-__.---__-..---- x Disposal Trench—No_ ____________________ Width.................... Total Length--.-__--_-_______-. Total leaching area--------------.-----sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area_--__.__-_-_--____sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by............................................................................ Date_---•---------------------------------- a Test Pit No. 1................minutes per inch Depth of Test Pit-------------------- Depth to ground water.-.._-..---.-.-..-.-.... rXq Test Pit No. 2................minutes per inch Depth of Test Pit.--_----___..__._.__ Depth to ground water-_.-.._.-_-_._-.--_--._. ------------------------- ODescription of Soil---------------------------------------- --------•`•--••--•-•-----•----•-------------------------------------------:....---•---- ..............._. --------------- -- x W --------------- --------------------- ------------------------------! --.....� ------------------- U Nature Alter do —Answ where appl' bee.._. -,.� r _ __ _____ ___ ___ _�.�__ _.__. .f� __,_____.__._..... t !1 -----•-------•--•---------------------------------------------------- Agreement: The undersignedlagrees tp install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article NI of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board OOj health:/ Signed,........................ ........... ll- Date ApplicationApproved By.................................................................................................. Date Application Disapproved for the following reasons:............................................................................................................... --------------------------------------------------------------------------------------------------------------------------------•-•--•---••-----••-•-----------------. -------------------------------- Date PermitNo......................................................... Issued........................................................ Date .r 3 ;. J .tz� �s � ��� �l� Az+) wq N bdhl5 r 3 r 1�t1�iD61n/5 � J a 3 i SYSTEM PROFILE ALL SHALL MARK DSTE WITHCMAGNETICTTAPE OR BE NOTES` 'i (NOT TO SCALE) COMPARABLE MEANS FOR FUTURE LOCATION. 1. DATUM IS APPROXIMATE NGVD MAIN HOUSE ACCESS COVERS TO WITHIN 6" OF FIN. GRADE CONCRETE COVERS TO WITHIN 3" GRADE DOOR SIU EL. 23.W 2" PEASTONE OR GEOTEXTILE (SEE VENT NOTE ON PLAN) 2• MUNICIPAL WATER IS EXISTING FILTER FABRIC OVER STONE PROVIDE CHECK VALVE \ 23.0 MINIMUM .75' OF COVER OVER PRECAST 23.0' > 23.0 2% SLOPE REQUIRED OVER SYSTEM 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. 5° PRECAST H-10 (RE-GRADE AS NECESSARY) PRECAST H_10 BLOCKS OR 20.0 -22 O 4. DESIGN LOADING FOR ALL PROPOSED PRECAST UNITS I 5 `OOL RISERS (1 YP.) RISERS (TYP.) -- :. 2•� y4 PRECAST RISERS �%' TO BE AASHO H-LQ . 4"SCH40 PVC 21 9' INSTALL INLET 4"4�SCH4� PVC H-10 TOP OF �SYSYEM EL. 17.0' NEW NON-GRINDER TEE 1" BELOW PIPES LE✓EL 1ST 2' MORTAR ALL 5. PIPE JOINTS TO BE MADE WATERTIGHT. i �{ EJECTOR PUMP GOULDS �ENDS NENTS WITHOUTLET INVERT COMPO INV' 160' 4 � l4+ 'tiGWP 23"x30" OR EQUAL *EXISTING **EXISTING 1000 GAL H-10 �� (TYP) SIDES° 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE �J 14• ? SEPTIC TANK 14• r` P°�°�o�o ° ° ° 310 CMR 15.000 (TITLE V.) LOCUS (SEE NOTE #13) 10• ° ° ° ° ° ° ° ° us ;y TEE 1500 GAL H-10 TEE 20.81' 20.75 10• 4' UQ. LEVEL T 20.5' ®®®® ®®®® ®®®® ��®® 'o°o°o°o° n SEPTIC TANK o 0 0 0 0 0 0 0 TEE o 0 0 0 0 0 0°0 0 0 ®®®®®®®®®®® ®®®®®® ®®®® 'o°o°o°o° 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND NOT TO 2"SCH40 PVC 21.08' 4' UQ. LEVEL GAS GARAGE BAFFLE GAS BAFFLE o oOOOOO20 0 0 °°O°O°O° °°°°°°00 GROUND EL 16.3't ACME OR EQUAL O > o 0 0 0 ®®®®®®®®®®® ®®®®®® ®®®® o 0 0 0 `� >°o°o°o°o ®®®®®®®®®®® ®®®®®®®®®®® ,°o°o°o°o BE USED FOR LOT LINE STAKING OR ANY OTHER 19.9' 19.73' °°°°°°°° PURPOSE. ;:; , ., •• L. 14. ' 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. eoc o0 0000O000°o°o°ono°o°ono 500 GAL. LEACHING CHAMBER BY ACME PRECAST OR EQUAL. on9 21.06 0 0 0 0 0 0 0 0 0 0 0 3/4"-1-1/2" DOUBLE WASHED STONE 4 ��H_20 (4) UNITS REQUIRED 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED 00 0-0-0-0-0 0 0 0 0 0 0 6" CRUSHED STONE OR MECHANICAL ALL AROUND PRECAST STRUCTURES WITHOUT INSPECTION BY BOARD OF HEALTH AND Nantucket DEPTH OF FLOW = 4 OVERALL DIMENSIONS TO OUTSIDE OF STONE: 42.00 X 12.83 PERMISSION OBTAINED FROM BOARD of HEALTH. COMPACTION. (15.221 [2]) q Sound TEE SIZES: 10• CONTRACTOR SHALL BE RESPONSIBLE FOR CALLING INLET DEPTH = 0" DICSAFE (1-888-344-7233) AND VERIFYING THE OUTLET DEPTH = 14" MIN.( 2 SLOPE) LOCATION OF ALL UNDERGROUND & OVERHEAD UTILITIES ( 1 SLOPE) ( 10 % SLOPE) 8.0 BOTTOM TH-1 PRIOR TO COMMENCEMENT OF WORK. LOCUS MAP PRIMARY SECONDARY ( 31 % SLOPE) NO GROUNDWATER FOUND 11. ANY UNSUITABLE MATERIAL ENCOUNTERED SHALL BE SCALE 1"=2000'f 12' SEPTIC T K 6' D BOX 12' LEACHING REMOVED 5' BENEATH AND AROUND THE PROPOSED FOUNDATION -"- SEPTIC TANK 6' LEACHING FACILITY. FACILITY ASSESSORS MAP` 207 PARCEL 65 12. EXISTING LEACHING FACILITY SHALL BE PUMPED AND ReovED OR PUMPED AND FILLED WITH CLEAN SAND. LOCUS IS WITHIN ESTUARINE WATERSHED DISTRICT 13 PER 310 CMR 15.229(2)(e) THE NEW NON-GRINDER LOCUS IS WITHIN AP OVERLAY DISTRICT EJ[CTOR PUMP MUST BE EQUIPPED WITH A STAND-BY OR A HOOK-UP FOR A STAND-BY POWER SOURCE. *THE INSTALLER SHALL VERIFY THE **THE INSTALLER SHALL CONFIRM MIN. LOCATIONS OF ALL UTILITIES AND ALL SEPTIC TANK SIZE AT 1000 GALLONS BUILDING SEWER OUTLETS AND AND ITS SUITABILITY FOR RE-USE AS ELEVATIONS PRIOR TO INSTALLING ANY SECONDARY TANK. �So PORTION OF SEPTIC SYSTEM Oilo� �� GAS TEST HOLE LOGS 9 MET R ENGINEER: DAVID FLAHERTY, R.S., SE2755 WITNESS: DON DESMARAIS, R.S. 27 EXISTING DATE: JULY 17, 2008 DWELLING VARIANCES FOR SEPTIC SYSTEM REPAIRS WHICH MAY BE < 2 MIN INCH -2s IMMEDIATELY GRANTED BY THE BOARD OF HEALTH AGENT OR PERC. RATE _ / BY HEALTH INSPECTOR CLASS I SOILS P# 12284 2s BENCHMARK: PAPERWORK AND HEARING REDUCTION PROPOSALS APPROVED DOOR SILL SYSTEM DESIGN: BENCHMARK: 2¢ ELEV. =23.94' BY THE BOARD OF HEALTH REVISED DURING A PUBLIC ELEV. ELEV. CORNER RET. WALL fi �G ,n ,� BRICK HEARING HELD ON NOVEMBER 15, 2005 , ELEV. = 26.8' wa GARBAGE DISPOSER IS NOT ALLOWED 0" 20.0' 0" 19.0' �2z AVEQ `� RES\N 27 3) FAILED SYSTEMS ONLY SOIL ABSORPTION SYSTEM �2> IVE INSTALLATIONS PROPOSED MORE THAN THREE FEET BELOW A A DESIGN FLOW: 5 BEDROOMS ® 110 GPD = 550 GPD LS LS 26 GRADE WITH PROPER VENTING (PIPED TO THE ATMOSPHERE) USE A, 550 GPD DESIGN FLOW AND WITH H-20 LOADING, BUT IN NO CASE SHALL THE SAS , 1OYR 4/1 10YR _4/1 BE LOCATED MORE THAN FIVE FEET BELOW,GRADE. - - r. �T_ ti __. TANK. a �Z) = ..I 1 QU PROVIDE-VENT WITH '� ' �" :. -.. _ SEPTIC, � B CHARCOAL FILTER 11.9 `�. AND BUGSCREEN O O Al 2� USE A 1500 GAL. SEPTIC TANK (PRIMARY) LS LS (FINAL PLACEMENT '``' RE-USE EXISTING GAL. SEPTIC TA (SECONDARY) /6 /6 r WITH HOMEOWNER i '�''•' .. . 2� ,; 1OYR 5 7, 1OYR 5 , ** U XIS 1000 TANK (SEGO ARY CONSULTATION) 28 17• 30 16.5 s MR FY T'"4 AT_ LEACHING: _2 2� ALL COMPONENTS TO BE 10' SAWCUT & PATCH FROM EXISTING WATERLINE SIDES: 2'(42 + 12.83) 2 (.74) = 162 GPD C C WITH ASPHALT TO w, �� (LOCATION APPROXIMATE) PERC MATCH EXISTING BOTTOM 42 x 12.83 (.74) = 398 GPD GRADES AS REQUIRED w �9 TOTAL: 756 S.F. 560 GPD FMS FMS USE (4) 500 GAL. H-20 LEACHING CHAMBERS (ACME OR EQUAL) M. CON r......._'�;, ���•k FOR GARAGE- WITH 4' STONE ALL AROUND 2.5Y 6/4 2.5Y 6/4 �- .. DECK ,8 1) INSTALLER SHALL DETERMINE /'••� k , ExISTING•'� FEASIBILITY OF RE-ROUTING PLUMBING GARAGE AND/OR SEWER LINE TO LOCATION AND ,. 16 ELEVATION AS SPECIFIED PER PLAN AS >>�� WELL AS THE FEASIBILTY OF INSTALLING MA 144" 8.0' 132" 8.0' • BRICK A NON-GRINDER SEWAGE EJECTOR PUMP. APPROVED DATE BOARD OF HEALTH PATIO NO GROUNDWATER ENCOUNTERED •� 2) INSTALLER SHALL ALSO DETERMINE THE FEASIBILITY AND THE ADEQUACY OF t CID i THE EXISTING ELECTRICAL SYSTEM TO ACCOMMODATE THE INSTALLATION OF THE EJECTOR PUMP. 0 LOT AREA 3) DISCHARGE FLOW RATE FOR .39 ACt NON-GRINDER EJECTOR PUMP SHALL BE LESS THAN 60 GPM (TDH) AND SHALL TITLE 5 SITE PLAN ONLY ACCOMMODATE LESS THAN 25% OF • THE TOTAL DESIGN FLOW FOR THE SYSTEM OF 4) A LICENSED PLUMBER AND A 419 SO. MAIN ST. LICENSED ELECTRICIAN MUST OBTAIN PERMITS FROM THE TOWN of (CENTERVILLE) BARNSTABLE, MA BARNSTABLE PRIOR TO PERFORMING WORK ON ANY RESPECTIVE ASPECTS OF PREPARED FOR THIS PROJECT. THE ESTATE OF RAYMOND SHANNON LEGEND .•� DATE: JULY 24, 2008 99- EXISTING CONTOUR • X 99.1 EXIST. SPOT ELEV. �• 99 PROPOSED CONTOUR 198.4) PROPOSED SPOT EL. TH1 _ _ TEST HOLE \ fax 508-362-9880 downcape.com 2% SLOPE OF GROUND ARNEOF � down cope e/1 inee�in , inc. CQD UTILITY POLE •` �o ARNE H �ivlL� o A� civil engineers FIRE HYDRANT •1 NOTE NOT ALL SYM&LS MAY APPEAR IN DRAWING SCCIIE: 1"= 2O' No. 30792 o No.26348 j land surveyors •� 0 10 20 30 40 50 FEET °F G, 939 Main Street ( Rte 6A) q YARMOUTHPORT MA 02675 DATE ARNE H. OJALA, P.E., P.L.S. LICE #08- 158 68-'158 SHANNON.DWG (DDF)